Psychiatric Questions II

Situation 7. Crisis is a temporary state of severe emotional disorganization resulting from failure of coping mechanisms or lack of support. Treatment should be immediate, supportive and directly responsive to the immediate crisis.

31. A nurse is reviewing the health care record of a client admitted to the psychiatric unit. The nurse notes that the admission nurse has documented that the client is experiencing anxiety as a result of a situational crisis. The nurse would determine that this type of crisis could be caused by:

a. A fire that destroyed the client's home

b. A recent rape episode experienced by the client

c. The death of a loved one

d. Witnessing a murder

32. A nurse is gathering data from a client in crisis. When determining the client's perception of the precipitating event that led to the crisis, the most appropriate question to ask is:

a. “What leads you to seek help now?”

b. “Who is available to help you?”

c. “What do you usually do to feel better?”

d. “With whom do you live?”

33. A nurse is assisting in developing a plan of care for a client in a crisis state. When developing the plan, the nurse will consider which of the following?

a. Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis.

b. A crisis state indicates that the individual is suffering from an emotional illness

c. A crisis state indicates that the individual is suffering from a mental illness

d. A client's response to a crisis is individualized and what constitutes a crisis for one person may not constitute a crisis for another person.

34. A female client, whose long term live-in lover has just terminated their relationship, come to the emergency service in severe crisis. After being seen by the nurse the client agrees to call the local mental health clinic for short term counseling. The nurse evaluates that the nursing intervention was effective based on the fact that the client:

a. Is seeking out assistance in making a decision

b. Has returned to her precrisis level of functioning

c. Has learned new methods of coping with her loss

d. Is demonstrating diminished symptoms of anxiety and sadness

35. During a staff development program, the nurse educator emphasizes that nurses caring for middle-agers who are experiencing midlife crisis should be aware that this crisis is most often due to the:

a. Individual's perception of his/her life situation

b. Many role changes adults experience at this time

c. Anticipation of negative changes associated with old age

d. Lack of support from family members who are busy with their own lives

Situation 8. The nurse was assigned to care for a client with a diagnosis of severe depression.

36. During a conversation with the depressed client on a psychiatric unit, the client says to the nurse “My family would be better off without me.” The nurse's best response is:

a. “Everyone feels this way when they are depressed.”

b. “Have you talked to your family about this?”

c. “You sound very upset. Are you thinking of hurting yourself?”

d. “You will feel better once your medication begins to work.”

37. The client recently lost her husband which aggravates her condition. The client says, “No one cares about me anymore. All the people I loved are dead.” Which of the following responses by the nurse is most therapeutic?

a. “That seems rather unlikely to me.”

b. “You must be feeling all alone at this point.”

c. “I don't believe that and neither do you.”

d. “Right! Why not just 'pack it in'?”

38. In caring for a client with severe depression, which of the following activities would be most appropriate?

a. Paint by number c. Drawing

b. A puzzle d. Checkers

39. Which behaviors observed by the nurse might lead to the suspicion that the client may be suicidal?

a. The client becomes angry while speaking on the telephone and slams the receiver down on the hook.

b. The client runs out of the therapy group swearing at the group leader and runs to her room.

c. The client gets angry with her roommate when the roommate borrows the client's clothes without asking.

d. The client gives away a prized CD and a cherished autograph picture of the performer.

40. The client has a history of serious suicidal attempt by hanging. The nurse's most important aspect of care is to maintain client safety. This is accomplished best by:

a. Assigning a staff member to the client who will remain with the client at all times.

b. Admitting the client to a seclusion room where all potentially dangerous articles are removed.

c. Removing the client's clothing and placing the client in a hospital gown

d. Requesting that a peer remain with the client at all times.

Situation 9. A nurse is tasked to take care of a client who is taking anti-manic medication.

41. The nurse is assisting in preparing a teaching plan for a client who is taking lithium carbonate (Eskalith). Which of the following would not be a component of the teaching plan?

a. Lithium blood levels must be monitored very closely.

b. Contact the physician if excessive diarrhea, vomiting or diaphoresis occurs.

c. Take the lithium with meals

d. Decrease fluid intake while taking the lithium

42. A client receiving lithium carbonate (Eskalith) complains of loose, watery stools and difficulty walking. The nurse would expect the serum lithium level to be which of the following?

a. 0.7 mEq/L c. 1.2 mEq/L

b. 1.0 mEq/L d. 1.7 mEq/L

43. A client who is on lithium carbonate (Eskalith) therapy is scheduled for surgery. The nurse informs the client that:

a. The medication will be discontinued several days before surgery and resumed by injection in the immediate postoperative period.

b. The medication is to be taken until the day of surgery and resumed by injection in the immediate postoperative period.

c. The medication will be discontinued 1 to 2 days before the surgery and resumes as soon as full oral intake is allowed.

d. The medication will be discontinued a week before the surgery and resumed a week after the surgery.

44. A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up evaluation and the level is 3.0 mEq/L. The nurse knows this level is:

a. Normal

b. Slightly above normal

c. Excessively below normal

d. Toxic

45. A client who is on lithium carbonate (Eskalith) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to:

a. Avoid soy sauce, wine, and aged cheese

b. Take medication only as prescribed because it can become addicting

c. Check with the psychiatrist before using any over-the-counter medications or prescription medications.

d. Have the lithium level checked every 2 weeks.

Situation 10. The following questions are related to anti-depressant medications

46. Fluoxetine HCl (Prozac) is prescribed for the client. The nurse provides instruction to the client regarding the administration of the medication. Which of the following statements if made by the client indicates an understanding regarding the administration of the medication:

a. “I should take the medication right before bedtime.”

b. “I should take the medication with my evening meal.”

c. “I should take the medication at noon time with an antacid.”

d. “I should take the medication in the morning when I first arise.”

47. When teaching a client who is being started on imipramine HCl (Tofranil), the nurse would inform the client that the desired effects of the medication may:

a. Start during the first week of administration

b. Start during the second week of administration

c. Not occur for 2 to 3 weeks of administration

d. Not occur until after a month of administration

48. A client admitted to the hospital gives the nurse a bottle of clomiprmine (Anafranil). The nurse notes that the medication has not taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this medication?

a. Frequent hand washing with hot soapy water

b. Complains of hunger

c. A pulse rate below 60 beats per minute

d. Complains of insomnia

49. A client arrives at the health care clinic and tells the nurse that they have been doubling the daily dosage of bupropion (Wellbutrin) to aid them in getting better faster. Which ongoing data collection is required based on this information?

a. Monitor for orthostatic hypotension

b. Monitor for seizure activity

c. Monitor for weight gain

d. Monitor for insomnia

50. A depressed client who is on tranylcypromine sulfate (Parnate) has been instructed on diet. The nurse feels confident that the client understands the diet when given a choice of restaurant foods if the client selects:

a. Pepperoni pizza, salad and cola

b. Roasted chicken, roasted potatoes and beer

c. Picked herring, french fries and milk

d. Fried haddock, baked potato and cola

Situation 11. Una, a 20 year old female client, was granted a weekend pass by the mental health unit.

51. During the one-on-one interaction with a nurse, Una states, “I'm worried about going home.” The nurse responds, “Tell me more about this.” This response is an example of:

a. Focusing c. Reflecting

b. Clarifying d. Refocusing

52. During a group discussion, it is learned that Una masked her depression and suicidal urges and indeed committed suicide several days ago. The group leaders should be prepared primarily to deal with:

a. The guilt that the group feels because they could not prevent another's suicide

b. The lack of concern over the member's suicide expressed by some of the group

c. The guilt, fear and anger of the co-leaders that they failed to anticipate and prevent the suicide

d. The fear and anxiety that some members of the group may have their own suicidal urges may go unnoticed and unprotected.

53. During the group discussion regarding the unexpected suicide of Una while on a weekend pass, one of the other clients stand up and shouts, “Oh, I know what you're all thinking; you think that I should have known that she was going to kill herself. You think I helped her plan this.” The most therapeutic response by the group leader would be:

a. “It will help if you tell us the truth.”

b. “Oh, no. We all know you liked her.”

c. “You fell we're blaming you for her death?”

d. “Helping another person to plan a suicide would not be healthy.”

54. During a special meeting to discuss the unexpected suicide of Una, the nurse overhears another client moan softly, “I'm next. Oh, my God, I'm next. They couldn't prevent hers and they can't protect me.” It would be most therapeutic for the nurse to respond by saying:

a. “You are afraid you will hurt yourself?”

b. “The other client was a lot sicker than you are.”

c. “It's different. The other client was home; you are here.”

d. “There is no need to worry. All passes will be canceled for a while.”

55. To deal in a growth-promoting manner with the occasional silence that occurs during a group session, the leaders should:

a. Be willing to sit indefinitely to wait the silence out

b. Call on specific members to talk when silence occurs

c. Go around the group, requiring each member to talk in turn

d. Comment on the silence or nonverbal behavior related to the silence

Situation 12. Psychiatric/Mental Health nursing caters to all clients from different age groups.

56. The most advantageous therapy for a preschool-aged child with a history of physical and sexual abuse would be:

a. Play therapy c. Group therapy

b. Psychodrama d. Family therapy

57. The nurse sits with an elderly depressed client twice a day, although there is little verbal communication. One afternoon, the client asks, “Do you think they'll ever let me out of here?” the nurse's best reply would be:

a. “Why don't you ask your doctor?”

b. “Everyone says you're doing just fine.”

c. “Why, do you think you are ready to leave”

d. “You have the feeling that you might not leave?”

58. The most therapeutic nursing intervention to help the late middle-aged individual deal with emotional aspects of aging would include:

a. Focusing on the individual's past experiences

b. Having the individual attend lectures on aging

c. Assisting the individual with plans for the future

d. Attentive listening to what the individual is saying

59. A nurse is assigned to care for a regressed 19 year old college student newly admitted to the psychiatric unit with a 1-month history of talking to unseen people and refusing to get out of bed, go to class, or get involved in daily grooming activities. The nurse's initial efforts should be directed toward helping the client by:

a. Providing frequent rest periods to avoid exhaustion

b. Facilitating the client's social relationships with a peer group

c. Reducing environmental stimuli and maintaining dietary intake

d. Attempting to establish a meaningful relationship with the client

60. A 45 year old physician is admitted to the psychiatric unit of a community hospital. The client is restless, loud, aggressive, and resistive during the admission procedure and states, “I will take my own blood pressure.” the most therapeutic response by the nurse would be:

a. “Right now, doctor, you are just another client.”

b. “I am sorry but I cannot allow that. I must take your BP.”

c. “If you would rather, doctor. I'm sure you will do it OK.”

d. “If you do not cooperate, I will get the attendants to hold you down.”